Iodoamino acid content and distribution in normal and abnormal human thyroids.

Iodoamino acid content and distribution were measured in adenomas, nodular goiters, thyroiditis and carcinomas and compared to thyroids from patients who died suddenly and normal thyroid tissues originally adjacent to diseased tissue. Tissues were hydrolyzed with Pronase, derivatized and analyzed by gas chromatography as had previously been reported for rat thyroids. Considerable overlap in values was found among adenomas, nodular goiters and papillary and follicular carcinomas as compared to values in normal thyroid tissue, but low values were also found in several diseased tissues. MIT/DIT and T3/T4 ratios were essentially constant in most tissues, even when T4 values were low. MIT/DIT ratios were, however, high and iodothyronines undetectable in all Hurthle cell neoplasms, clearly differentiating them from other thyroid conditions.

Current Status of Classification and Staging of Prostate Cancer.

The international TNM classification system for prostatic cancer has been recently revised and is most helpful for comparisons between various groups of patients. Today in the United States, the evaluation of certain factors related to clinical and pathologic staging are being further altered. These include primary grade of tumor and the extent and techniques of tumor staging. New tests for acid phosphatase and alkaline phosphatase isozymes are being concurrently evaluated. Advances in the past six years have contributed to further redefinition and subgrouping of previous conventional staging or prognostic assessment of prostatic cancer. Localized (Stage B, C), occult (Stage A), or generalized (Stage D) tumors are being subdivided. Although grade of the primary tumor has been thought to be important only recently has a consensus been achieved by the National Prostatic Cancer Project for a system of assessment that uses cellular patterns and nuclear changes. Aspiration cytology may be a useful adjuvant. The role and type of pelvic lymph node assessment, whether operative, radiographic, or by thin needle percutaneous aspiration, is undergoing additional study. In dealing with the so-called occult (Stage A) lesions, a further subdivision, Stage A,/A2 has been employed. Similar changes in so-called B1 /B2 , C1 /C2 , and D1 /D2 also exist. These are valid attempts to further define extent of disease and overall true tumor burden. Nevertheless, it is still the privilege of the physician to determine the necessity and extent of the use of such classification. Today, the decision to provide therapeutic care based only on a clinical stage must be made with the knowledge of these variations of classification and staging as well as of other developments.

Validation of left ventricular volume measurements by radionuclide angiography.

A nongeometric, attenuation-corrected technique to quantitate left ventricular volumes using equilibrium radionuclide angiography was validated in vitro and in vivo. In vitro experiments were performed to derive a linear attenuation coefficient, which was then employed in the volume determinations using balloons in a water bath. Good in vitro correlation was found between radionuclide and actual volumes (r = 0.99, p less than 0.0001), over a wide range (5 to 400 ml). In vivo validation was done by comparing the nuclear technique to contrast angiography in 29 patients: Good correlations were found for end-diastolic volume (r = 0.98), end-systolic volume (r = 0.95), stroke volume (r = 0.96), and ejection fraction (r = 0.85). When the conventional linear attenuation coefficient was used, the radionuclide technique consistently overestimated volumes in vitro and in vivo. Although high intraobserver and interobserver correlation coefficients were found (r from 0.88 to 0.93), significant individual variability existed, particularly in the interobserver data. Our data provide unique validation of radionuclide volume determinations, using an experimentally determined attenuation coefficient, which results in improved accuracy.

Prognostic factors in bladder cancer. A pathologic, immunohistochemical, and DNA flow-cytometric study.

Pathologic grade and stage, immunohistochemical analysis of eight cell and tumor markers, and DNA ploidy were studied in 36 cases of bladder cancer to determine the features of value in assessment of patients' survival. Tumors of high grade and advanced stage correlated with DNA aneuploidy, whereas low grade and early stage correlated with DNA diploidy when simultaneously evaluated with survival. In addition, blood group isoantigen A correlated with DNA ploidy in deceased patients, whereas blood group isoantigen H and oncogene-related protein p21 correlated with DNA ploidy in surviving patients. Despite the relatively small number of cases studied, these results suggest that pathologic grade and stage and immunohistochemical analysis of blood group isoantigens A and H and oncogene-related protein p21 hold additional value in the prediction of bladder cancer survival when evaluated simultaneously with DNA ploidy.

Renal cortical tumors. Cytogenetic characterization.

The authors examined three cortical tumors (adenomas) of the kidney and found a consistent chromosome pattern. A combination of chromosome abnormalities (+7, +7, +17, -Y) was shared by these tumors. In contrast, none of them showed alterations of chromosome 3p and 5q, the most common changes in renal cell carcinomas. The chromosome abnormalities in these patients may define a subgroup of renal tumors, so-called adenomas, that cannot be distinguished easily from adenocarcinomas in histopathologic examination.

Translocation t(4;11)(q35;p13) in an adrenocortical carcinoma.

Chromosome studies were performed on an adrenocortical carcinoma extending into the kidney. The following karyotype was present in all metaphases: 46,XX,t(4;11)(q35;p13). Two metaphases with an additional del(1)(q23) were found. The results are briefly discussed in relation to specific karyotypic changes in cancer, in general, and to those of adrenocortical tumors, in particular.

Pattern of care and follow-up of stages A1, B1 prostatic cancers from multicenter group, the National Prostatic Cancer Treatment Group (NPCTG).

In 1981, the National Prostatic Cancer Treatment Group began an open survey of available A1, B1 prostatic adenocarcinomas to determine outcome and clinical characteristics. Their report as of September, 1985, summarizes the outcome and important features of the survey. The majority of A1 cases had a low tumor grade I and were followed. Stage B1 received surgery or radiation generally. The B1 tumor grade was approximately one-third grade I, II, or III-IV. Presently, symptoms differ, as would be expected. Follow-up data to date have indicated no major changes. In some of the special study cases (12/52), the stage was changed as a result of the central laboratory review.

Functioning malignant nonchromaffin paraganglioma of retroperitoneum with metastases.

A case is reported of a functioning, malignant nonchromaffin paraganglioma (chemodectoma) of the retroperitoneum with metastases in a seventeen-year-old boy. The literature is reviewed and the treatment modalities are discussed.

Hypernephroma arising in wall of simple renal cyst.

An unusual case of hypernephroma arising from the wall of a simple renal cyst is presented. Despite prior controversy as to the existence of this entity continuity between normal and neoplastic cells lining the cyst wall was demonstrated thus confirming this lesion as a distinct entity. Furthermore, we wish to direct attention to the limitations of biochemical and cytologic analysis of renal cyst fluid in distinguishing benign and neoplastic lesions.

Neuroblastoma presenting as renal cell carcinoma in an adult.

A rare case of a fifty-six-year-old female with neuroblastoma is presented. Possible implications as to etiology are discussed, and the radiographic similarities between renal cell carcinoma and neuroblastoma are presented.

Malignant phyllodes tumor of prostate.

A case of malignant phyllodes tumor of the prostate, with clinical course of recurrence and pulmonary metastasis is described in a thirty-eight-year-old man. Histologically the tumor was characterized by a fibrosarcoma-like pattern with adjacent changes of fibroadenoma and phyllodes type of prostatic atypical hyperplasia. The pathology, histogenesis, differential diagnosis, and the role of immunohistochemistry in the diagnosis and demonstration of its components is reviewed.

Comparative evaluation of National Prostatic Cancer Treatment Group and Gleason systems for pathologic grading of primary prostatic cancer.

Multivariable analysis was used to investigate the relationship between risk of disease progression or death in patients who were treated with adjuvant therapy after definitive treatment for prostatic adenocarcinoma and the components of the National Prostatic Cancer Treatment Group (NPCTG) and Gleason systems for pathologic grading of prostatic cancer. Data were available for 203 patients who were treated on NPCTG Protocols 900 and 1,000, which involve surgical and radiation therapy as definitive treatment. Since less than 10 per cent of these patients have died, analysis of survival was not attempted. The study focus was progression-free survival, which is the minimum of time to progression or death. The analysis demonstrates that a new measure, the NPCTG score (the sum of the glandular and nuclear grades) is superior to the previously reported NPCTG grade (the maximum of the two grades). In addition, the Gleason score is somewhat superior to the new NPCTG score. All of this, however, applies only to the primary tumor and not the nature of any present or future metastatic lesions.

Light and ultrastructural studies of renal oncocytic adenoma.

An asymptomatic renal oncocytoma was found in the upper left quadrant of an eighty-five-year-old woman during a routine physical examination. Ultrastructurally, the tumor was composed entirely of epithelial cells filled with normal and abnormal mitochondria. Selective renal angiography showed two renal arteries supplying a lobulated, highly vascular mass. The mass contained irregular and tortuous vessels without any arteriovenous shunting.

Endometrial carcinoma of prostate.

Endometrial carcinoma of the prostate is a unique lesion which contrasts markedly to the more ubiquitous prostatic acinar carcinoma with regard to morphology, clinical manifestations, localization stage at diagnosis, and possibly prognosis. Although endometrial carcinoma of the prostate may occur more commonly than previously recognized, wider recognition and study are essential for further delineation of this lesion. Finally, the inherent limits of endoscopic or of enucleative surgery and the propensity of endometrial carcinoma to present at a low stage suggest in appropriately selected cases that radical prostatectomy or possible external radiotherapy may offer the best opportunity for cure.

A functional parathyroid gland adenoma of transitional oxyphil cells. A light and ultrastructural study.

This report describes light and ultrastructural features of a functional parathyroid gland adenoma, principally composed of transitional oxyphil cells, in a 64-yr-old hypertensive black woman. She was hospitalized for repeated episodes of headaches, lethargy, and dizzy spells. Her serum calcium level was 2.92 mmol/l and immunoassay for parathormone was 390 pg/ml. On neck exploration, the left lower parathyroid gland was found enlarged and therefore removed in toto. The serum calcium and phosphate levels returned to normal following parathyroidectomy. Microscopically, the diagnosis of functional oxyphil adenoma was made. On ultrastructural examination, the tumour was composed principally of transitional cells, occasional typical, and degenerating oxyphil cells. The predominant transitional cells were rich in mitochondria and contained multiple active Golgi complexes, stacked profiles of rough endoplasmic reticulum, and a few secretory granules. On the other hand, typical oxyphil cells were tightly packed with mitochondria at the expense of other organelles. It appeared that neoplastic oxyphil cells were chief cells transformed in response to some unknown oncogenic stimulus.

Osteosarcoma.

Osteosarcoma is the most common bone tumor of children and adolescents. The peak incidence of the disease is in the 15 to 19 year age group. The disease is more commonly seen in males than females. While several factors, including exposure to radiation, genetic disorders such as retinoblastoma, and high rate of bone growth, have been associated with osteosarcoma, in most cases no definite etiology can be established. Osteosarcoma usually originates in the metaphyseal region of long bones and extends through the cortex, causing varying degrees of bone destruction and expansion of periosteum. The radiographic appearance caused by this process is often referred to as "sun burst" sign. Positive diagnosis of osteosarcoma is made by histopathology. The histopathological classification of osteosarcoma can also predict the degree of aggressive behavior of this tumor and thus has prognostic significance. Surgery, including amputation or limb-salvage procedure, is the mainstay of treatment of osteosarcoma. It is now unequivocally established that adjuvant chemotherapy will prolong the survival of patients with this disease. Chemotherapy agents often used include platinum derivates, methotrexate, vincristine, cyclophosphamide, adriamycin, actinomycin D, bleomycin and DTIC. Depending on surgical decision, these agents can be used prior to or after the operation. Immediate fitting with prosthesis and provision of appropriate medical and psychological support in the care of these patients is essential.

Prognosis of bladder carcinoma in patients treated with cystectomy.

Prognostic criteria for bladder tumors are the stage and grade of the tumor in the present series of 82 patients, in which all patients received the same treatment. These criteria are related and the combined evaluation increases the prognostic accuracy for the disease. In addition, the diameter and not the number of bladder tumors on primary diagnosis is an important prognostic sign. A significant number of tumors at the first clinical evaluation were apparently understaged and undergraded and to a lesser degree overstaged and overgraded as compared with cystectomy specimen evaluations. Despite the total cystectomy, even the patients with superficial bladder lesions, a significant number died from the bladder tumor and 1/4 of the patients had metastases at post mortem examination. The 5 year overall survival with total cystectomy was 40% and for 10 years 15%. Other adjuvant forms of therapy pre- and post-operatively must be assessed.